{"reporting_entity_name":"Centene Management Company LLC","reporting_entity_type":"Third Party Administrator","version":"2.0.0","last_updated_on":"2026-04-28","out_of_network":[{"name":"Under Proprietary Laboratory Analyses","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"0340U","description":"Under Proprietary Laboratory Analyses","allowed_amounts":[{"tin":{"type":"ein","value":"10894487"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":66663.24,"providers":[{"billed_charge":119800.00,"npi":[1558672279]}]}]}]},{"name":"MED-SUR-GY/PVT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"111","description":"ROOM AND BOARD - PRIVATE -MEDICAL/SURGICAL/GYN","allowed_amounts":[{"tin":{"type":"ein","value":"721561134"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":26130.53,"providers":[{"billed_charge":9051.00,"npi":[1982733655]}]}]}]},{"name":"PEDS/PVT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"113","description":"ROOM AND BOARD - PRIVATE -PEDIATRIC","allowed_amounts":[{"tin":{"type":"ein","value":"860422559"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":81468.00,"providers":[{"billed_charge":135780.00,"npi":[1760480503]}]}]}]},{"name":"PSTAY/2 BED","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"124","description":"ROOM AND BOARD - SEMI PRIVATE TWO BED -PSYCHIATRIC","allowed_amounts":[{"tin":{"type":"ein","value":"270355566"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":140372.66,"providers":[{"billed_charge":177200.00,"npi":[1083942098]}]}]}]},{"name":"DETOX/2 BED","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"126","description":"ROOM AND BOARD - SEMI PRIVATE TWO BED -DETOXIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"270355566"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":35277.70,"providers":[{"billed_charge":37655.00,"npi":[1083942098]}]}]},{"tin":{"type":"ein","value":"472097678"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":2222.91,"providers":[{"billed_charge":13317.66,"npi":[1972132231]}]}]}]},{"name":"POST ICU","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"206","description":"INTENSIVE CARE - POST ICU","allowed_amounts":[{"tin":{"type":"ein","value":"721561132"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":388838.16,"providers":[{"billed_charge":396630.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":120488.04,"providers":[{"billed_charge":99720.00,"npi":[1982733655]}]}]}]},{"name":"PHARMACY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"250","description":"PHARMACY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"352263845"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1460.95,"providers":[{"billed_charge":1314.00,"npi":[1992735088]}]}]},{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":10990.20,"providers":[{"billed_charge":18317.00,"npi":[1760480503]}]},{"allowed_amount":116168.38,"providers":[{"billed_charge":305700.00,"npi":[1760480503]}]},{"allowed_amount":8821.32,"providers":[{"billed_charge":15687.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"851516898"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":38.37,"providers":[{"billed_charge":438.40,"npi":[1518539048]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":450.00,"providers":[{"billed_charge":5645.64,"npi":[1700910189]}]},{"allowed_amount":704.19,"providers":[{"billed_charge":366194.62,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"383990879"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":299.60,"providers":[{"billed_charge":4703.00,"npi":[1689121188]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1003.19,"providers":[{"billed_charge":5663.00,"npi":[1982733655]}]},{"allowed_amount":435.75,"providers":[{"billed_charge":97510.00,"npi":[1982733655]}]}]},{"tin":{"type":"ein","value":"860800150"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1125.71,"providers":[{"billed_charge":4742.20,"npi":[1154392231]}]}]},{"tin":{"type":"ein","value":"463533638"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":192.20,"providers":[{"billed_charge":2056.00,"npi":[1992131734]}]}]}]},{"name":"DRUGS/GENERIC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"251","description":"PHARMACY - GENERIC DRUGS","allowed_amounts":[{"tin":{"type":"ein","value":"866007596"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3.93,"providers":[{"billed_charge":13.10,"npi":[1194706655]}]}]}]},{"name":"DRUGS/INCIDNT RAD","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"255","description":"PHARMACY - DRUGS INCIDENT TO RADIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"860800150"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":305.41,"providers":[{"billed_charge":649.50,"npi":[1154392231]}]}]}]},{"name":"IV SOLUTIONS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"258","description":"PHARMACY - IV SOLUTIONS","allowed_amounts":[{"tin":{"type":"ein","value":"851516898"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7.95,"providers":[{"billed_charge":456.00,"npi":[1518539048]}]}]}]},{"name":"IV THERAPY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"260","description":"IV THERAPY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":4041.40,"providers":[{"billed_charge":4879.00,"npi":[1760480503]}]},{"allowed_amount":2580.82,"providers":[{"billed_charge":5260.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"860181654"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9666.12,"providers":[{"billed_charge":62187.00,"npi":[1114744752]}]}]},{"tin":{"type":"ein","value":"352263845"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":555.02,"providers":[{"billed_charge":1202.00,"npi":[1992735088]}]}]},{"tin":{"type":"ein","value":"851516898"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5453.33,"providers":[{"billed_charge":22366.40,"npi":[1518539048]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3362.10,"providers":[{"billed_charge":38720.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":32946.35,"providers":[{"billed_charge":129728.00,"npi":[1982733655]}]}]},{"tin":{"type":"ein","value":"860800150"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":142.94,"providers":[{"billed_charge":4184.00,"npi":[1154392231]}]}]},{"tin":{"type":"ein","value":"463533638"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7815.46,"providers":[{"billed_charge":25766.00,"npi":[1992131734]}]}]}]},{"name":"STERILE SUPPLY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"272","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY","allowed_amounts":[{"tin":{"type":"ein","value":"833547294"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":960.47,"providers":[{"billed_charge":3201.56,"npi":[1609496397]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":66.81,"providers":[{"billed_charge":328.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":324.00,"providers":[{"billed_charge":73217.00,"npi":[1982733655]}]},{"allowed_amount":36.00,"providers":[{"billed_charge":120.00,"npi":[1982733655]}]},{"allowed_amount":180.00,"providers":[{"billed_charge":240.00,"npi":[1982733655]}]}]}]},{"name":"SUPPLY/IMPLANTS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"278","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS","allowed_amounts":[{"tin":{"type":"ein","value":"721561132"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":990.00,"providers":[{"billed_charge":3300.00,"npi":[1700910189]}]}]}]},{"name":"LABORATORY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"LABORATORY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"352263845"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":215.88,"providers":[{"billed_charge":2328.00,"npi":[1992735088]}]}]},{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":102.00,"providers":[{"billed_charge":170.00,"npi":[1760480503]}]},{"allowed_amount":1094.40,"providers":[{"billed_charge":1824.00,"npi":[1760480503]}]},{"allowed_amount":377.76,"providers":[{"billed_charge":742.47,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"900214335"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":40.19,"providers":[{"billed_charge":501.00,"npi":[1194705202]}]}]},{"tin":{"type":"ein","value":"383990879"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":386.02,"providers":[{"billed_charge":2832.00,"npi":[1689121188]}]}]},{"tin":{"type":"ein","value":"860212139"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":3118.85,"providers":[{"billed_charge":3118.85,"npi":[1083643738]}]},{"allowed_amount":7816.74,"providers":[{"billed_charge":8887.17,"npi":[1083643738]}]}]},{"tin":{"type":"ein","value":"473255211"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1594.94,"providers":[{"billed_charge":2181.00,"npi":[1265813075]}]}]},{"tin":{"type":"ein","value":"860800150"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":192.12,"providers":[{"billed_charge":1053.00,"npi":[1154392231]}]}]},{"tin":{"type":"ein","value":"463533638"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":44.45,"providers":[{"billed_charge":1340.00,"npi":[1992131734]}]}]},{"tin":{"type":"ein","value":"821703810"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2811.40,"providers":[{"billed_charge":17309.89,"npi":[1356818496]}]}]},{"tin":{"type":"ein","value":"833547294"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":811.76,"providers":[{"billed_charge":4097.50,"npi":[1609496397]}]}]},{"tin":{"type":"ein","value":"471587223"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":183.20,"providers":[{"billed_charge":4130.00,"npi":[1154748416]}]}]},{"tin":{"type":"ein","value":"862195601"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":613.54,"providers":[{"billed_charge":4671.69,"npi":[1881352037]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":646.08,"providers":[{"billed_charge":3276.00,"npi":[1700910189]}]},{"allowed_amount":168.00,"providers":[{"billed_charge":16972.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":201.00,"providers":[{"billed_charge":21775.00,"npi":[1982733655]}]},{"allowed_amount":1008.59,"providers":[{"billed_charge":13869.00,"npi":[1982733655]}]}]},{"tin":{"type":"ein","value":"866007596"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":597.33,"providers":[{"billed_charge":4847.00,"npi":[1194706655]}]}]}]},{"name":"LAB/CHEMISTRY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"LABORATORY - CHEMISTRY","allowed_amounts":[{"tin":{"type":"ein","value":"352263845"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4880.79,"providers":[{"billed_charge":91232.00,"npi":[1992735088]}]}]},{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":27937.34,"providers":[{"billed_charge":54999.00,"npi":[1760480503]}]},{"allowed_amount":61671.40,"providers":[{"billed_charge":101758.00,"npi":[1760480503]}]},{"allowed_amount":70933.20,"providers":[{"billed_charge":165949.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"383990879"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5640.22,"providers":[{"billed_charge":73040.00,"npi":[1689121188]}]}]},{"tin":{"type":"ein","value":"860810876"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":259.46,"providers":[{"billed_charge":719.19,"npi":[1225023179]}]},{"allowed_amount":90.54,"providers":[{"billed_charge":90.54,"npi":[1225023179]}]}]},{"tin":{"type":"ein","value":"860212139"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":367.17,"providers":[{"billed_charge":367.17,"npi":[1083643738]}]}]},{"tin":{"type":"ein","value":"860800150"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":5274.06,"providers":[{"billed_charge":26831.00,"npi":[1154392231]}]},{"allowed_amount":162.40,"providers":[{"billed_charge":203.00,"npi":[1154392231]}]}]},{"tin":{"type":"ein","value":"463533638"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3331.72,"providers":[{"billed_charge":48814.00,"npi":[1992131734]}]}]},{"tin":{"type":"ein","value":"370635502"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":221.85,"providers":[{"billed_charge":1165.00,"npi":[1982796181]}]},{"allowed_amount":4802.00,"providers":[{"billed_charge":4802.00,"npi":[1982796181]}]}]},{"tin":{"type":"ein","value":"860181654"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":24.59,"providers":[{"billed_charge":65586.00,"npi":[1114744752]}]}]},{"tin":{"type":"ein","value":"860098923"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1397.74,"providers":[{"billed_charge":5506.00,"npi":[1902897820]}]}]},{"tin":{"type":"ein","value":"851516898"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4203.56,"providers":[{"billed_charge":46498.00,"npi":[1518539048]}]}]},{"tin":{"type":"ein","value":"471587223"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5966.06,"providers":[{"billed_charge":122421.00,"npi":[1154748416]}]}]},{"tin":{"type":"ein","value":"42791396"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":241.69,"providers":[{"billed_charge":399.27,"npi":[1295765261]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23","20","21"],"billing_class":"institutional","payments":[{"allowed_amount":8963.25,"providers":[{"billed_charge":621532.60,"npi":[1700910189]}]},{"allowed_amount":12712.82,"providers":[{"billed_charge":222590.00,"npi":[1700910189]}]},{"allowed_amount":33.75,"providers":[{"billed_charge":45.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3057.00,"providers":[{"billed_charge":316709.00,"npi":[1982733655]}]},{"allowed_amount":1367.57,"providers":[{"billed_charge":7489.00,"npi":[1609408665]}]},{"allowed_amount":337.50,"providers":[{"billed_charge":450.00,"npi":[1982733655]}]},{"allowed_amount":19221.05,"providers":[{"billed_charge":223708.09,"npi":[1982733655]}]}]}]},{"name":"LAB/IMMUNOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"302","description":"LABORATORY - IMMUNOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":752.36,"providers":[{"billed_charge":1408.00,"npi":[1760480503]}]},{"allowed_amount":1785.60,"providers":[{"billed_charge":3104.00,"npi":[1760480503]}]},{"allowed_amount":1159.80,"providers":[{"billed_charge":1933.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":81.30,"providers":[{"billed_charge":1054.00,"npi":[1700910189]}]},{"allowed_amount":349.50,"providers":[{"billed_charge":5982.40,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":330.75,"providers":[{"billed_charge":23390.00,"npi":[1982733655]}]},{"allowed_amount":185.54,"providers":[{"billed_charge":4139.00,"npi":[1982733655]}]}]}]},{"name":"LAB/HEMATOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"305","description":"LABORATORY - HEMATOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":12728.20,"providers":[{"billed_charge":21087.00,"npi":[1760480503]}]},{"allowed_amount":6822.60,"providers":[{"billed_charge":15616.00,"npi":[1760480503]}]},{"allowed_amount":5296.67,"providers":[{"billed_charge":9624.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"352263845"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1130.31,"providers":[{"billed_charge":15662.00,"npi":[1992735088]}]}]},{"tin":{"type":"ein","value":"851516898"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1020.24,"providers":[{"billed_charge":21558.00,"npi":[1518539048]}]}]},{"tin":{"type":"ein","value":"471587223"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1227.03,"providers":[{"billed_charge":37104.00,"npi":[1154748416]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2486.35,"providers":[{"billed_charge":34164.00,"npi":[1700910189]}]},{"allowed_amount":1035.75,"providers":[{"billed_charge":88676.40,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"383990879"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1216.38,"providers":[{"billed_charge":24506.00,"npi":[1689121188]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2151.00,"providers":[{"billed_charge":101910.00,"npi":[1982733655]}]},{"allowed_amount":3564.32,"providers":[{"billed_charge":58686.60,"npi":[1982733655]}]},{"allowed_amount":425.25,"providers":[{"billed_charge":567.00,"npi":[1982733655]}]}]},{"tin":{"type":"ein","value":"860800150"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2625.37,"providers":[{"billed_charge":5431.00,"npi":[1154392231]}]}]},{"tin":{"type":"ein","value":"463533638"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":409.84,"providers":[{"billed_charge":8221.00,"npi":[1992131734]}]}]}]},{"name":"LAB/BACT-MIRCO","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"306","description":"LABORATORY - BACTERIOLOGY & MICROBIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"352263845"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":938.40,"providers":[{"billed_charge":2711.00,"npi":[1992735088]}]}]},{"tin":{"type":"ein","value":"860181654"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":202.53,"providers":[{"billed_charge":4182.00,"npi":[1114744752]}]}]},{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":24780.88,"providers":[{"billed_charge":43082.00,"npi":[1760480503]}]},{"allowed_amount":17818.80,"providers":[{"billed_charge":29698.00,"npi":[1760480503]}]},{"allowed_amount":27347.40,"providers":[{"billed_charge":74868.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"833547294"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2225.73,"providers":[{"billed_charge":10162.91,"npi":[1609496397]}]}]},{"tin":{"type":"ein","value":"471587223"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7904.01,"providers":[{"billed_charge":35378.00,"npi":[1154748416]}]}]},{"tin":{"type":"ein","value":"851516898"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":863.04,"providers":[{"billed_charge":3234.00,"npi":[1518539048]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23","20","21"],"billing_class":"institutional","payments":[{"allowed_amount":3963.00,"providers":[{"billed_charge":5284.00,"npi":[1700910189]}]},{"allowed_amount":1209.00,"providers":[{"billed_charge":55782.76,"npi":[1700910189]}]},{"allowed_amount":2082.72,"providers":[{"billed_charge":11141.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"383990879"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5477.07,"providers":[{"billed_charge":22998.00,"npi":[1689121188]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":8451.07,"providers":[{"billed_charge":66142.00,"npi":[1982733655]}]},{"allowed_amount":264.75,"providers":[{"billed_charge":62542.00,"npi":[1982733655]}]}]},{"tin":{"type":"ein","value":"860800150"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2203.47,"providers":[{"billed_charge":6230.00,"npi":[1154392231]}]}]},{"tin":{"type":"ein","value":"463533638"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1273.18,"providers":[{"billed_charge":9841.00,"npi":[1992131734]}]}]}]},{"name":"LAB/UROLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"307","description":"LABORATORY - UROLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":622.80,"providers":[{"billed_charge":1264.00,"npi":[1760480503]}]},{"allowed_amount":858.42,"providers":[{"billed_charge":1518.00,"npi":[1760480503]}]},{"allowed_amount":333.60,"providers":[{"billed_charge":556.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"352263845"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":130.87,"providers":[{"billed_charge":1345.00,"npi":[1992735088]}]}]},{"tin":{"type":"ein","value":"471587223"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1011.58,"providers":[{"billed_charge":30079.00,"npi":[1154748416]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23","20"],"billing_class":"institutional","payments":[{"allowed_amount":1197.75,"providers":[{"billed_charge":1694.00,"npi":[1700910189]}]},{"allowed_amount":279.55,"providers":[{"billed_charge":5326.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"383990879"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":890.81,"providers":[{"billed_charge":17213.00,"npi":[1689121188]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":147.00,"providers":[{"billed_charge":5202.00,"npi":[1982733655]}]},{"allowed_amount":871.28,"providers":[{"billed_charge":17293.00,"npi":[1982733655]}]}]},{"tin":{"type":"ein","value":"860212139"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":30.12,"providers":[{"billed_charge":30.12,"npi":[1083643738]}]}]},{"tin":{"type":"ein","value":"860800150"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":374.09,"providers":[{"billed_charge":1025.00,"npi":[1154392231]}]},{"allowed_amount":28.00,"providers":[{"billed_charge":35.00,"npi":[1154392231]}]}]},{"tin":{"type":"ein","value":"463533638"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":43.62,"providers":[{"billed_charge":661.00,"npi":[1992131734]}]}]}]},{"name":"LAB/OTHER","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"309","description":"LABORATORY - OTHER LABORATORY","allowed_amounts":[{"tin":{"type":"ein","value":"721561132"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":104.21,"providers":[{"billed_charge":1954.00,"npi":[1700910189]}]},{"allowed_amount":1230.75,"providers":[{"billed_charge":27074.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":629.25,"providers":[{"billed_charge":17353.00,"npi":[1982733655]}]},{"allowed_amount":691.50,"providers":[{"billed_charge":922.00,"npi":[1982733655]}]},{"allowed_amount":258.87,"providers":[{"billed_charge":6975.00,"npi":[1982733655]}]}]}]},{"name":"DX X-RAY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"320","description":"RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":9874.04,"providers":[{"billed_charge":18008.00,"npi":[1760480503]}]},{"allowed_amount":14480.40,"providers":[{"billed_charge":24134.00,"npi":[1760480503]}]},{"allowed_amount":4913.40,"providers":[{"billed_charge":8189.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"471587223"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1289.80,"providers":[{"billed_charge":40226.00,"npi":[1154748416]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23","20"],"billing_class":"institutional","payments":[{"allowed_amount":992.24,"providers":[{"billed_charge":11868.00,"npi":[1700910189]}]},{"allowed_amount":2794.50,"providers":[{"billed_charge":3726.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"383990879"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":754.89,"providers":[{"billed_charge":18011.00,"npi":[1689121188]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2656.87,"providers":[{"billed_charge":44724.55,"npi":[1982733655]}]}]},{"tin":{"type":"ein","value":"860212139"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1760.51,"providers":[{"billed_charge":1760.51,"npi":[1083643738]}]},{"allowed_amount":740.47,"providers":[{"billed_charge":740.47,"npi":[1083643738]}]}]}]},{"name":"DX X-RAY/CHEST","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"324","description":"RADIOLOGY - DIAGNOSTIC - CHEST X-RAY","allowed_amounts":[{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1665.60,"providers":[{"billed_charge":2776.00,"npi":[1760480503]}]},{"allowed_amount":4774.80,"providers":[{"billed_charge":8652.00,"npi":[1760480503]}]},{"allowed_amount":7485.27,"providers":[{"billed_charge":12920.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"352263845"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1206.92,"providers":[{"billed_charge":5518.00,"npi":[1992735088]}]}]},{"tin":{"type":"ein","value":"860181654"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":938.52,"providers":[{"billed_charge":4571.00,"npi":[1114744752]}]}]},{"tin":{"type":"ein","value":"471587223"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7853.49,"providers":[{"billed_charge":29794.00,"npi":[1154748416]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23","20"],"billing_class":"institutional","payments":[{"allowed_amount":4080.86,"providers":[{"billed_charge":14881.00,"npi":[1700910189]}]},{"allowed_amount":342.00,"providers":[{"billed_charge":456.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"383990879"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4111.30,"providers":[{"billed_charge":17165.00,"npi":[1689121188]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7669.03,"providers":[{"billed_charge":31063.00,"npi":[1982733655]}]}]},{"tin":{"type":"ein","value":"860800150"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":70.20,"providers":[{"billed_charge":160.00,"npi":[1154392231]}]}]}]},{"name":"CT SCAN/HEAD","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"351","description":"CT SCAN - HEAD SCAN","allowed_amounts":[{"tin":{"type":"ein","value":"471587223"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7774.57,"providers":[{"billed_charge":61015.00,"npi":[1154748416]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4831.95,"providers":[{"billed_charge":46450.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"383990879"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1426.38,"providers":[{"billed_charge":18313.00,"npi":[1689121188]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":15478.63,"providers":[{"billed_charge":135623.00,"npi":[1982733655]}]}]}]},{"name":"CT SCAN/BODY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"352","description":"CT SCAN - BODY SCAN","allowed_amounts":[{"tin":{"type":"ein","value":"352263845"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7158.09,"providers":[{"billed_charge":69559.00,"npi":[1992735088]}]}]},{"tin":{"type":"ein","value":"471587223"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":40101.93,"providers":[{"billed_charge":396664.00,"npi":[1154748416]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":25888.67,"providers":[{"billed_charge":231314.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"383990879"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":21054.08,"providers":[{"billed_charge":199999.00,"npi":[1689121188]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":45276.78,"providers":[{"billed_charge":486685.00,"npi":[1982733655]}]}]},{"tin":{"type":"ein","value":"860800150"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6457.28,"providers":[{"billed_charge":22089.00,"npi":[1154392231]}]}]},{"tin":{"type":"ein","value":"463533638"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2476.50,"providers":[{"billed_charge":14266.00,"npi":[1992131734]}]}]}]},{"name":"OR SERVICES","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"360","description":"OPERATING ROOM SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":84903.00,"providers":[{"billed_charge":155180.00,"npi":[1760480503]}]},{"allowed_amount":15939.00,"providers":[{"billed_charge":26565.00,"npi":[1760480503]}]},{"allowed_amount":111823.00,"providers":[{"billed_charge":186371.67,"npi":[1760480503]}]}]}]},{"name":"ROUTINE VENIPUNCTURE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"36415","description":"COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE","allowed_amounts":[{"tin":{"type":"ein","value":"203134104"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":6.00,"providers":[{"billed_charge":59.20,"npi":[1073578159]}]},{"allowed_amount":9.00,"providers":[{"billed_charge":88.80,"npi":[1033166012]}]}]},{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4543.42,"providers":[{"billed_charge":65683.63,"npi":[1740262880]}]}]},{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":24.15,"providers":[{"billed_charge":329.50,"npi":[1538144910]}]}]}]},{"name":"ANESTHESIA","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"370","description":"ANESTHESIA - GENERAL CLASSIFICATIION","allowed_amounts":[{"tin":{"type":"ein","value":"860422559"},"service_code":["22","21"],"billing_class":"institutional","payments":[{"allowed_amount":40248.00,"providers":[{"billed_charge":67080.00,"npi":[1760480503]}]},{"allowed_amount":34665.00,"providers":[{"billed_charge":60385.00,"npi":[1760480503]}]}]}]},{"name":"ULTRASOUND","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"402","description":"OTHER IMAGING SERVICES - ULTRASOUND","allowed_amounts":[{"tin":{"type":"ein","value":"352263845"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":280.14,"providers":[{"billed_charge":1918.00,"npi":[1992735088]}]}]},{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2698.20,"providers":[{"billed_charge":5363.00,"npi":[1760480503]}]},{"allowed_amount":8122.20,"providers":[{"billed_charge":13537.00,"npi":[1760480503]}]},{"allowed_amount":4698.60,"providers":[{"billed_charge":7831.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"471587223"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":105.60,"providers":[{"billed_charge":756.00,"npi":[1154748416]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":912.34,"providers":[{"billed_charge":7397.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3560.35,"providers":[{"billed_charge":28312.00,"npi":[1982733655]}]}]}]},{"name":"INHALATION SVC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"412","description":"RESPIRATORY SERVICES - INHALATION SERVICES","allowed_amounts":[{"tin":{"type":"ein","value":"721561134"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":79.58,"providers":[{"billed_charge":1728.00,"npi":[1982733655]}]}]}]},{"name":"EMERG ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"450","description":"EMERGENCY ROOM - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"352263845"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":60519.02,"providers":[{"billed_charge":275244.00,"npi":[1992735088]}]}]},{"tin":{"type":"ein","value":"860422559"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":68580.60,"providers":[{"billed_charge":147745.00,"npi":[1760480503]}]},{"allowed_amount":381366.98,"providers":[{"billed_charge":723202.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"383990879"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":206418.41,"providers":[{"billed_charge":797680.00,"npi":[1689121188]}]}]},{"tin":{"type":"ein","value":"860212139"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":14372.80,"providers":[{"billed_charge":14524.00,"npi":[1083643738]}]}]},{"tin":{"type":"ein","value":"473255211"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5428.06,"providers":[{"billed_charge":8884.00,"npi":[1265813075]}]}]},{"tin":{"type":"ein","value":"860800150"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":74235.98,"providers":[{"billed_charge":228103.00,"npi":[1154392231]}]}]},{"tin":{"type":"ein","value":"463533638"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":45704.46,"providers":[{"billed_charge":201980.00,"npi":[1992131734]}]}]},{"tin":{"type":"ein","value":"860181654"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":52130.45,"providers":[{"billed_charge":228427.00,"npi":[1114744752]}]}]},{"tin":{"type":"ein","value":"860098923"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8035.22,"providers":[{"billed_charge":12566.00,"npi":[1902897820]}]}]},{"tin":{"type":"ein","value":"833547294"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":53717.34,"providers":[{"billed_charge":186072.91,"npi":[1609496397]}]}]},{"tin":{"type":"ein","value":"851516898"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":58347.69,"providers":[{"billed_charge":116470.00,"npi":[1518539048]}]}]},{"tin":{"type":"ein","value":"471587223"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":323536.06,"providers":[{"billed_charge":1134922.00,"npi":[1154748416]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":111426.59,"providers":[{"billed_charge":504190.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"862195601"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3460.14,"providers":[{"billed_charge":22803.01,"npi":[1881352037]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":23072.75,"providers":[{"billed_charge":36420.00,"npi":[1265065445]}]},{"allowed_amount":39055.01,"providers":[{"billed_charge":65107.00,"npi":[1609408665]}]},{"allowed_amount":208421.47,"providers":[{"billed_charge":759818.67,"npi":[1982733655]}]}]}]},{"name":"URGENT CARE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"456","description":"EMERGENCY ROOM - URGENT CARE","allowed_amounts":[{"tin":{"type":"ein","value":"721561132"},"service_code":["20"],"billing_class":"institutional","payments":[{"allowed_amount":12837.01,"providers":[{"billed_charge":16977.60,"npi":[1700910189]}]}]}]},{"name":"ECHOCARDIOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"483","description":"CARDIOLOGY - ECHOCARDIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":17065.20,"providers":[{"billed_charge":28442.00,"npi":[1760480503]}]},{"allowed_amount":1675.80,"providers":[{"billed_charge":2793.00,"npi":[1760480503]}]},{"allowed_amount":6031.20,"providers":[{"billed_charge":20570.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":366.19,"providers":[{"billed_charge":4099.00,"npi":[1700910189]}]}]}]},{"name":"DRUG/DETAIL CODE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"636","description":"DRUGS REQ SPEC IDENTIFICATION - DRUGS REQ DETAILED CODING*","allowed_amounts":[{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":15010.20,"providers":[{"billed_charge":30169.00,"npi":[1760480503]}]},{"allowed_amount":32902.10,"providers":[{"billed_charge":53656.00,"npi":[1760480503]}]},{"allowed_amount":4984.24,"providers":[{"billed_charge":8709.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"352263845"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2419.26,"providers":[{"billed_charge":31482.00,"npi":[1992735088]}]}]},{"tin":{"type":"ein","value":"383990879"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2657.13,"providers":[{"billed_charge":85781.00,"npi":[1689121188]}]}]},{"tin":{"type":"ein","value":"850105601"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":179.70,"providers":[{"billed_charge":599.00,"npi":[1215913470]}]}]},{"tin":{"type":"ein","value":"860212139"},"service_code":["22","23","24"],"billing_class":"institutional","payments":[{"allowed_amount":367.06,"providers":[{"billed_charge":367.06,"npi":[1083643738]}]},{"allowed_amount":185.56,"providers":[{"billed_charge":216.36,"npi":[1083643738]}]},{"allowed_amount":1117.00,"providers":[{"billed_charge":1117.00,"npi":[1083643738]}]}]},{"tin":{"type":"ein","value":"941461843"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":375.00,"providers":[{"billed_charge":1250.00,"npi":[1740215219]}]}]},{"tin":{"type":"ein","value":"473255211"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":21.69,"providers":[{"billed_charge":72.29,"npi":[1265813075]}]}]},{"tin":{"type":"ein","value":"860800150"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1630.73,"providers":[{"billed_charge":9555.40,"npi":[1154392231]}]}]},{"tin":{"type":"ein","value":"463533638"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":21941.03,"providers":[{"billed_charge":41846.00,"npi":[1992131734]}]}]},{"tin":{"type":"ein","value":"821703810"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1054.48,"providers":[{"billed_charge":5411.45,"npi":[1356818496]}]}]},{"tin":{"type":"ein","value":"860181654"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":0.43,"providers":[{"billed_charge":9160.30,"npi":[1114744752]}]},{"allowed_amount":225.51,"providers":[{"billed_charge":27177.00,"npi":[1114744752]}]}]},{"tin":{"type":"ein","value":"860098923"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":168.98,"providers":[{"billed_charge":495.00,"npi":[1902897820]}]}]},{"tin":{"type":"ein","value":"833547294"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3479.88,"providers":[{"billed_charge":11598.50,"npi":[1609496397]}]}]},{"tin":{"type":"ein","value":"471587223"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2109.40,"providers":[{"billed_charge":114212.00,"npi":[1154748416]}]}]},{"tin":{"type":"ein","value":"851516898"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3928.82,"providers":[{"billed_charge":21609.54,"npi":[1518539048]}]}]},{"tin":{"type":"ein","value":"951644036"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":228.00,"providers":[{"billed_charge":760.00,"npi":[1407828429]}]}]},{"tin":{"type":"ein","value":"862195601"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":319.23,"providers":[{"billed_charge":4030.05,"npi":[1881352037]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23","20","21"],"billing_class":"institutional","payments":[{"allowed_amount":263.25,"providers":[{"billed_charge":351.00,"npi":[1700910189]}]},{"allowed_amount":2403.00,"providers":[{"billed_charge":732489.00,"npi":[1700910189]}]},{"allowed_amount":5178.76,"providers":[{"billed_charge":92587.25,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3681.00,"providers":[{"billed_charge":158644.00,"npi":[1982733655]}]},{"allowed_amount":8141.25,"providers":[{"billed_charge":10855.00,"npi":[1982733655]}]},{"allowed_amount":6430.15,"providers":[{"billed_charge":21101.50,"npi":[1982733655]}]},{"allowed_amount":168.25,"providers":[{"billed_charge":2172.00,"npi":[1609408665]}]},{"allowed_amount":185.27,"providers":[{"billed_charge":472.00,"npi":[1265065445]}]}]},{"tin":{"type":"ein","value":"550261260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6.00,"providers":[{"billed_charge":20.00,"npi":[1629015698]}]}]}]},{"name":"RECOVERY ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"710","description":"RECOVERY ROOM - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4131.00,"providers":[{"billed_charge":6885.00,"npi":[1760480503]}]},{"allowed_amount":12255.00,"providers":[{"billed_charge":24225.00,"npi":[1760480503]}]},{"allowed_amount":38967.00,"providers":[{"billed_charge":64945.00,"npi":[1760480503]}]}]}]},{"name":"EKG/ECG","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"730","description":"EKG/ECG - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"352263845"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":504.30,"providers":[{"billed_charge":10740.00,"npi":[1992735088]}]}]},{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4728.00,"providers":[{"billed_charge":7880.00,"npi":[1760480503]}]},{"allowed_amount":1773.00,"providers":[{"billed_charge":3940.00,"npi":[1760480503]}]},{"allowed_amount":3841.50,"providers":[{"billed_charge":6895.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"471587223"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":576.88,"providers":[{"billed_charge":27291.00,"npi":[1154748416]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1402.62,"providers":[{"billed_charge":27924.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"383990879"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":435.48,"providers":[{"billed_charge":14059.00,"npi":[1689121188]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2502.90,"providers":[{"billed_charge":31747.00,"npi":[1982733655]}]},{"allowed_amount":449.25,"providers":[{"billed_charge":27554.00,"npi":[1982733655]}]}]},{"tin":{"type":"ein","value":"860800150"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":344.76,"providers":[{"billed_charge":3571.00,"npi":[1154392231]}]}]}]},{"name":"OBSERVATION ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"762","description":"TREATMENT OR OBSERVATION ROOM - OBSERVATION ROOM","allowed_amounts":[{"tin":{"type":"ein","value":"860422559"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3168.00,"providers":[{"billed_charge":20862.00,"npi":[1760480503]}]},{"allowed_amount":2755.54,"providers":[{"billed_charge":6864.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1990.29,"providers":[{"billed_charge":24390.00,"npi":[1700910189]}]}]}]},{"name":"BREAST TOMOSYNTHESIS BI","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77063","description":"SCREENING DIGITAL BREAST TOMOSYNTHESIS, BILATERAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY P","allowed_amounts":[{"tin":{"type":"ein","value":"200382536"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":948.56,"providers":[{"billed_charge":4636.00,"npi":[1154558039]}]}]}]},{"name":"SCR MAMMO BI INCL CAD","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77067","description":"SCREENING MAMMOGRAPHY, BILATERAL (2-VIEW STUDY OF EACH BREAST), INCLUDING COMPUTER-AIDED DETECTION (","allowed_amounts":[{"tin":{"type":"ein","value":"200382536"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2318.20,"providers":[{"billed_charge":11210.00,"npi":[1154558039]}]}]}]},{"name":"RADIATION TREATMENT DELIVERY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77407","description":"RADIATION TREATMENT DELIVERY, =>1 MEV; INTERMEDIATE","allowed_amounts":[{"tin":{"type":"ein","value":"860938204"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4489.98,"providers":[{"billed_charge":14047.00,"npi":[1306342266]}]}]}]},{"name":"METABOLIC PANEL TOTAL CA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80048","description":"BASIC METABOLIC PANEL (CALCIUM, TOTAL) THIS PANEL MUST INCLUDE THE FOLLOWING: CALCIUM, TOTAL (82310)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":440.64,"providers":[{"billed_charge":3079.66,"npi":[1740262880]}]}]}]},{"name":"COMPREHEN METABOLIC PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80053","description":"COMPREHENSIVE METABOLIC PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTA","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":26610.08,"providers":[{"billed_charge":168121.34,"npi":[1740262880]}]}]}]},{"name":"LIPID PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80061","description":"LIPID PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: CHOLESTEROL, SERUM, TOTAL (82465) LIPOPROTEIN, DI","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":22152.39,"providers":[{"billed_charge":220657.18,"npi":[1740262880]}]}]}]},{"name":"RENAL FUNCTION PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80069","description":"RENAL FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) CALCIUM, TOTAL (82310) C","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":66.50,"providers":[{"billed_charge":488.70,"npi":[1740262880]}]}]}]},{"name":"ACUTE HEPATITIS PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80074","description":"ACUTE HEPATITIS PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: HEPATITIS A ANTIBODY (HAAB), IGM ANTIBO","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3235.96,"providers":[{"billed_charge":43111.76,"npi":[1740262880]}]}]}]},{"name":"HEPATIC FUNCTION PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80076","description":"HEPATIC FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTAL (8224","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":156.50,"providers":[{"billed_charge":1214.29,"npi":[1740262880]}]}]}]},{"name":"DRUG TEST PRSMV DIR OPT OBS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80305","description":"DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; CAPABLE ","allowed_amounts":[{"tin":{"type":"ein","value":"870847992"},"service_code":["11","99"],"billing_class":"professional","payments":[{"allowed_amount":113.40,"providers":[{"billed_charge":567.00,"npi":[1871547380]}]},{"allowed_amount":6.30,"providers":[{"billed_charge":31.50,"npi":[1871547380]}]}]}]},{"name":"DRUG TEST PRSMV INSTRMNT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80306","description":"DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; READ BY ","allowed_amounts":[{"tin":{"type":"ein","value":"454995568"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":167.10,"providers":[{"billed_charge":300.00,"npi":[1891971628]}]}]}]},{"name":"DRUG TEST PRSMV CHEM ANLYZR","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80307","description":"DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; BY INSTR","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1334.85,"providers":[{"billed_charge":2285.89,"npi":[1740262880]}]}]}]},{"name":"URINALYSIS AUTO W/SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81001","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, ","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":952.56,"providers":[{"billed_charge":14540.14,"npi":[1740262880]}]}]}]},{"name":"URINALYSIS NONAUTO W/O SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81002","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, ","allowed_amounts":[{"tin":{"type":"ein","value":"203134104"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3.48,"providers":[{"billed_charge":17.40,"npi":[1033166012]}]},{"allowed_amount":6.96,"providers":[{"billed_charge":34.80,"npi":[1073578159]}]}]}]},{"name":"URINALYSIS AUTO W/O SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81003","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, ","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":165.12,"providers":[{"billed_charge":3145.35,"npi":[1740262880]}]}]}]},{"name":"URINE PREGNANCY TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81025","description":"URINE PREGNANCY TEST, BY VISUAL COLOR COMPARISON METHODS","allowed_amounts":[{"tin":{"type":"ein","value":"870847992"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":8.62,"providers":[{"billed_charge":69.00,"npi":[1871547380]}]}]}]},{"name":"FETAL CHRMOML ANEUPLOIDY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81420","description":"FETAL CHROMOSOMAL ANEUPLOIDY (EG, TRISOMY 21, MONOSOMY X) GENOMIC SEQUENCE ANALYSIS PANEL, CIRCULATI","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5978.26,"providers":[{"billed_charge":9779.41,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF ACTH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82024","description":"ADRENOCORTICOTROPIC HORMONE (ACTH)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":29.60,"providers":[{"billed_charge":279.30,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF SERUM ALBUMIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82040","description":"ALBUMIN; SERUM, PLASMA OR WHOLE BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":444.58,"providers":[{"billed_charge":843.43,"npi":[1740262880]}]}]}]},{"name":"MICROALBUMIN, QUANTITATIVE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82043","description":"ALBUMIN; URINE (EG, MICROALBUMIN), QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2273.28,"providers":[{"billed_charge":38058.62,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF BREATH ETHANOL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82075","description":"ALCOHOL (ETHANOL), BREATH","allowed_amounts":[{"tin":{"type":"ein","value":"870847992"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":270.00,"providers":[{"billed_charge":810.00,"npi":[1871547380]}]}]}]},{"name":"ALPHA-FETOPROTEIN, SERUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82105","description":"ALPHA-FETOPROTEIN (AFP); SERUM","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":30.36,"providers":[{"billed_charge":355.95,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF AMYLASE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82150","description":"AMYLASE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":84.49,"providers":[{"billed_charge":1008.41,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF APOLIPOPROTEIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82172","description":"APOLIPOPROTEIN, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":724.07,"providers":[{"billed_charge":2326.76,"npi":[1740262880]}]}]}]},{"name":"BILIRUBIN, TOTAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82247","description":"BILIRUBIN; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":421.75,"providers":[{"billed_charge":538.09,"npi":[1740262880]}]}]}]},{"name":"BILIRUBIN, DIRECT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82248","description":"BILIRUBIN; DIRECT","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":179.85,"providers":[{"billed_charge":345.70,"npi":[1740262880]}]}]}]},{"name":"VITAMIN D 25 HYDROXY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82306","description":"VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":24416.11,"providers":[{"billed_charge":403995.70,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF CALCIUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82310","description":"CALCIUM; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":400.13,"providers":[{"billed_charge":527.35,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF CALCIUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82330","description":"CALCIUM; IONIZED","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":30.81,"providers":[{"billed_charge":305.24,"npi":[1740262880]}]}]}]},{"name":"ASSAY, BLOOD CARBON DIOXIDE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82374","description":"CARBON DIOXIDE (BICARBONATE)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":75.74,"providers":[{"billed_charge":85.67,"npi":[1740262880]}]}]}]},{"name":"CARCINOEMBRYONIC ANTIGEN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82378","description":"CARCINOEMBRYONIC ANTIGEN (CEA)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":479.82,"providers":[{"billed_charge":4508.29,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF BLOOD CHLORIDE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82435","description":"CHLORIDE; BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":348.68,"providers":[{"billed_charge":444.14,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF COPPER","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82525","description":"COPPER","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":85.58,"providers":[{"billed_charge":819.00,"npi":[1740262880]}]}]}]},{"name":"TOTAL CORTISOL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82533","description":"CORTISOL; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2035.88,"providers":[{"billed_charge":18991.23,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF CK (CPK)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82550","description":"CREATINE KINASE (CK), (CPK); TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":99.80,"providers":[{"billed_charge":843.27,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF CREATININE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82565","description":"CREATININE; BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":475.60,"providers":[{"billed_charge":1189.92,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF URINE CREATININE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82570","description":"CREATININE; OTHER SOURCE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2023.58,"providers":[{"billed_charge":32688.16,"npi":[1740262880]}]}]}]},{"name":"VITAMIN B-12","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82607","description":"CYANOCOBALAMIN (VITAMIN B-12);","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":6895.35,"providers":[{"billed_charge":63927.71,"npi":[1740262880]}]}]}]},{"name":"DEHYDROEPIANDROSTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82626","description":"DEHYDROEPIANDROSTERONE (DHEA)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":96.85,"providers":[{"billed_charge":1215.24,"npi":[1740262880]}]}]}]},{"name":"DEHYDROEPIANDROSTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82627","description":"DEHYDROEPIANDROSTERONE-SULFATE (DHEA-S)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3390.96,"providers":[{"billed_charge":35187.39,"npi":[1740262880]}]}]}]},{"name":"DIHYDROTESTOSTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82642","description":"DIHYDROTESTOSTERONE (DHT)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":291.59,"providers":[{"billed_charge":2459.25,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF ESTRADIOL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82670","description":"ESTRADIOL","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":12011.01,"providers":[{"billed_charge":99875.23,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF ESTROGEN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82672","description":"ESTROGENS; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":914.10,"providers":[{"billed_charge":9646.41,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF ESTRONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82679","description":"ESTRONE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":994.76,"providers":[{"billed_charge":10615.55,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF FERRITIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82728","description":"FERRITIN","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4791.96,"providers":[{"billed_charge":39892.13,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF FOLIC ACID SERUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82746","description":"FOLIC ACID; SERUM","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4744.67,"providers":[{"billed_charge":44238.56,"npi":[1740262880]}]}]}]},{"name":"ASSAY IGA/IGD/IGG/IGM EACH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82784","description":"GAMMAGLOBULIN (IMMUNOGLOBULIN); IGA, IGD, IGG, IGM, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":332.70,"providers":[{"billed_charge":6538.64,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF IGE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82785","description":"GAMMAGLOBULIN (IMMUNOGLOBULIN); IGE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":227.16,"providers":[{"billed_charge":2093.13,"npi":[1740262880]}]}]}]},{"name":"ASSAY, GLUCOSE, BLOOD QUANT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82947","description":"GLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":243.27,"providers":[{"billed_charge":610.44,"npi":[1740262880]}]}]}]},{"name":"GLUCOSE TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82950","description":"GLUCOSE; POST GLUCOSE DOSE (INCLUDES GLUCOSE)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":447.72,"providers":[{"billed_charge":3865.35,"npi":[1740262880]}]}]}]},{"name":"GLUCOSE TOLERANCE TEST (GTT)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82951","description":"GLUCOSE; TOLERANCE TEST (GTT), 3 SPECIMENS (INCLUDES GLUCOSE)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":53.60,"providers":[{"billed_charge":344.84,"npi":[1740262880]}]}]}]},{"name":"GTT-ADDED SAMPLES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82952","description":"GLUCOSE; TOLERANCE TEST, EACH ADDITIONAL BEYOND 3 SPECIMENS (LIST SEPARATELY IN ADDITION TO CODE FOR","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":15.00,"providers":[{"billed_charge":91.62,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF GGT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82977","description":"GLUTAMYLTRANSFERASE, GAMMA (GGT)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":491.28,"providers":[{"billed_charge":3513.13,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF GONADOTROPIN (FSH)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83001","description":"GONADOTROPIN; FOLLICLE STIMULATING HORMONE (FSH)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5468.16,"providers":[{"billed_charge":46573.73,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF GONADOTROPIN (LH)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83002","description":"GONADOTROPIN; LUTEINIZING HORMONE (LH)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4186.05,"providers":[{"billed_charge":35349.51,"npi":[1740262880]}]}]}]},{"name":"H PYLORI (C-13), BREATH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83013","description":"HELICOBACTER PYLORI; BREATH TEST ANALYSIS FOR UREASE ACTIVITY, NON-RADIOACTIVE ISOTOPE (EG, C-13)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1341.86,"providers":[{"billed_charge":8667.00,"npi":[1740262880]}]}]}]},{"name":"GLYCOSYLATED HEMOGLOBIN TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83036","description":"HEMOGLOBIN; GLYCOSYLATED (A1C)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":14485.68,"providers":[{"billed_charge":150905.47,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF HOMOCYSTINE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83090","description":"HOMOCYSTEINE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":711.15,"providers":[{"billed_charge":10537.36,"npi":[1740262880]}]}]}]},{"name":"IMMUNOASSAY NONANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83516","description":"IMMUNOASSAY FOR ANALYTE OTH THAN INFECTIOUS AGENT ANTIBODY OR INFECTIOUS AGENT ANTIGEN; QUALITATIVE ","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":123.75,"providers":[{"billed_charge":2007.08,"npi":[1740262880]}]}]}]},{"name":"IMMUNOASSAY QUANT NOS NONAB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83520","description":"IMMUNOASSAY FOR ANALYTE OTHER THAN INFECTIOUS AGENT ANTIBODY OR INFECTIOUS AGENT ANTIGEN; QUANTITATI","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":555.51,"providers":[{"billed_charge":11130.19,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF INSULIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83525","description":"INSULIN; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":886.45,"providers":[{"billed_charge":12201.53,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF IRON","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83540","description":"IRON","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2236.13,"providers":[{"billed_charge":16457.94,"npi":[1740262880]}]}]}]},{"name":"IRON BINDING TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83550","description":"IRON BINDING CAPACITY","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2646.50,"providers":[{"billed_charge":19418.48,"npi":[1740262880]}]}]}]},{"name":"LACTATE (LD) (LDH) ENZYME","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83615","description":"LACTATE DEHYDROGENASE (LD), (LDH);","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":406.39,"providers":[{"billed_charge":2227.84,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF LIPASE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83690","description":"LIPASE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":142.56,"providers":[{"billed_charge":1628.80,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF LIPOPROTEIN(A)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83695","description":"LIPOPROTEIN (A)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":138.88,"providers":[{"billed_charge":2152.25,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF MAGNESIUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83735","description":"MAGNESIUM","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":894.36,"providers":[{"billed_charge":8582.88,"npi":[1740262880]}]}]}]},{"name":"MASS SPECTROMETRY QUAL/QUAN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83789","description":"MASS SPECTROMETRY AND TANDEM MASS SPECTROMETRY (EG, MS, MS/MS, MALDI, MS-TOF, QTOF), NON-DRUG ANALYT","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":13.84,"providers":[{"billed_charge":77.70,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF PARATHORMONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83970","description":"PARATHORMONE (PARATHYROID HORMONE)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1549.87,"providers":[{"billed_charge":10069.08,"npi":[1740262880]}]}]}]},{"name":"ASSAY ALKALINE PHOSPHATASE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84075","description":"PHOSPHATASE, ALKALINE;","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":414.32,"providers":[{"billed_charge":479.21,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF PHOSPHORUS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84100","description":"PHOSPHORUS INORGANIC (PHOSPHATE);","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":417.35,"providers":[{"billed_charge":2851.14,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF SERUM POTASSIUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84132","description":"POTASSIUM; SERUM, PLASMA OR WHOLE BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":213.63,"providers":[{"billed_charge":330.96,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF PREGNENOLONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84140","description":"PREGNENOLONE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":79.20,"providers":[{"billed_charge":694.30,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF PROGESTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84144","description":"PROGESTERONE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5660.46,"providers":[{"billed_charge":50804.25,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF PROLACTIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84146","description":"PROLACTIN","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1885.95,"providers":[{"billed_charge":18247.99,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF PSA, TOTAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84153","description":"PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3592.95,"providers":[{"billed_charge":30392.70,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF PSA, FREE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84154","description":"PROSTATE SPECIFIC ANTIGEN (PSA); FREE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":619.96,"providers":[{"billed_charge":4443.96,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF PROTEIN SERUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84155","description":"PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; SERUM, PLASMA OR WHOLE BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":332.30,"providers":[{"billed_charge":726.30,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF PROTEIN, URINE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84156","description":"PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; URINE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":118.02,"providers":[{"billed_charge":1484.64,"npi":[1740262880]}]}]}]},{"name":"PROTEIN E-PHORESIS, SERUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84165","description":"PROTEIN; ELECTROPHORETIC FRACTIONATION AND QUANTITATION, SERUM","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":24.69,"providers":[{"billed_charge":204.15,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF SEX HORMONE GLOBUL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84270","description":"SEX HORMONE BINDING GLOBULIN (SHBG)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1738.50,"providers":[{"billed_charge":16206.50,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF SERUM SODIUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84295","description":"SODIUM; SERUM, PLASMA OR WHOLE BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":363.22,"providers":[{"billed_charge":445.11,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF SOMATOMEDIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84305","description":"SOMATOMEDIN","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":423.54,"providers":[{"billed_charge":8353.32,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF FREE TESTOSTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84402","description":"TESTOSTERONE; FREE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":10437.85,"providers":[{"billed_charge":99622.67,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF TOTAL TESTOSTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84403","description":"TESTOSTERONE; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":14103.18,"providers":[{"billed_charge":132010.79,"npi":[1740262880]}]}]},{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":19.78,"providers":[{"billed_charge":206.85,"npi":[1538144910]}]}]}]},{"name":"ASSAY OF VITAMIN B-1","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84425","description":"THIAMINE (VITAMIN B-1)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":97.62,"providers":[{"billed_charge":891.31,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF TOTAL THYROXINE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84436","description":"THYROXINE; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":578.60,"providers":[{"billed_charge":5323.16,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF FREE THYROXINE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84439","description":"THYROXINE; FREE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":6820.17,"providers":[{"billed_charge":104038.40,"npi":[1740262880]}]}]}]},{"name":"ASSAY THYROID STIM HORMONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84443","description":"THYROID STIMULATING HORMONE (TSH)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":24491.61,"providers":[{"billed_charge":236163.17,"npi":[1740262880]}]}]}]},{"name":"TRANSFERASE (AST) (SGOT)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84450","description":"TRANSFERASE; ASPARTATE AMINO (AST) (SGOT)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":475.84,"providers":[{"billed_charge":935.28,"npi":[1740262880]}]}]}]},{"name":"ALANINE AMINO (ALT) (SGPT)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84460","description":"TRANSFERASE; ALANINE AMINO (ALT) (SGPT)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":216.70,"providers":[{"billed_charge":841.87,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF TRANSFERRIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84466","description":"TRANSFERRIN","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":225.17,"providers":[{"billed_charge":2031.98,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF THYROID (T3 OR T4)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84479","description":"THYROID HORMONE (T3 OR T4) UPTAKE OR THYROID HORMONE BINDING RATIO (THBR)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":208.32,"providers":[{"billed_charge":1955.12,"npi":[1740262880]}]}]}]},{"name":"ASSAY, TRIIODOTHYRONINE (T3)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84480","description":"TRIIODOTHYRONINE T3; TOTAL (TT-3)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":271.75,"providers":[{"billed_charge":3019.15,"npi":[1740262880]}]}]}]},{"name":"FREE ASSAY (FT-3)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84481","description":"TRIIODOTHYRONINE T3; FREE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":7289.80,"providers":[{"billed_charge":122576.13,"npi":[1740262880]}]}]}]},{"name":"T3 REVERSE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84482","description":"TRIIODOTHYRONINE T3; REVERSE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":773.12,"providers":[{"billed_charge":14838.63,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF UREA NITROGEN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84520","description":"UREA NITROGEN; QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":333.37,"providers":[{"billed_charge":606.07,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF BLOOD/URIC ACID","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84550","description":"URIC ACID; BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":508.16,"providers":[{"billed_charge":3980.95,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF ZINC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84630","description":"ZINC","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":113.49,"providers":[{"billed_charge":1289.30,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF C-PEPTIDE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84681","description":"C-PEPTIDE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":169.51,"providers":[{"billed_charge":1342.84,"npi":[1740262880]}]}]}]},{"name":"CHORIONIC GONADOTROPIN TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84702","description":"GONADOTROPIN, CHORIONIC (HCG); QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":817.76,"providers":[{"billed_charge":6292.93,"npi":[1740262880]}]}]}]},{"name":"HEMATOCRIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85014","description":"BLOOD COUNT; HEMATOCRIT (HCT)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":32.58,"providers":[{"billed_charge":387.08,"npi":[1740262880]}]}]}]},{"name":"HEMOGLOBIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85018","description":"BLOOD COUNT; HEMOGLOBIN (HGB)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":18.10,"providers":[{"billed_charge":168.22,"npi":[1740262880]}]}]}]},{"name":"COMPLETE CBC W/AUTO DIFF WBC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85025","description":"BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT) AND AUTOMATED DIFFERE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":14094.00,"providers":[{"billed_charge":111564.39,"npi":[1740262880]}]}]}]},{"name":"COMPLETE CBC, AUTOMATED","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85027","description":"BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":703.56,"providers":[{"billed_charge":5542.95,"npi":[1740262880]}]}]}]},{"name":"AUTOMATED RETICULOCYTE COUNT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85045","description":"BLOOD COUNT; RETICULOCYTE, AUTOMATED","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3.07,"providers":[{"billed_charge":44.10,"npi":[1740262880]}]}]}]},{"name":"PROTHROMBIN TIME","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85610","description":"PROTHROMBIN TIME;","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":460.51,"providers":[{"billed_charge":6220.24,"npi":[1740262880]}]}]}]},{"name":"RBC SED RATE, AUTOMATED","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85652","description":"SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":403.65,"providers":[{"billed_charge":7145.16,"npi":[1740262880]}]}]}]},{"name":"THROMBOPLASTIN TIME, PARTIAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85730","description":"THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":437.00,"providers":[{"billed_charge":6085.56,"npi":[1740262880]}]}]}]},{"name":"ANTINUCLEAR ANTIBODIES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86038","description":"ANTINUCLEAR ANTIBODIES (ANA);","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1093.86,"providers":[{"billed_charge":11782.31,"npi":[1740262880]}]}]}]},{"name":"C-REACTIVE PROTEIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86140","description":"C-REACTIVE PROTEIN;","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":776.16,"providers":[{"billed_charge":13368.97,"npi":[1740262880]}]}]}]},{"name":"C-REACTIVE PROTEIN, HS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86141","description":"C-REACTIVE PROTEIN; HIGH SENSITIVITY (HSCRP)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1448.32,"providers":[{"billed_charge":12027.38,"npi":[1740262880]}]}]}]},{"name":"CARDIOLIPIN ANTIBODY EA IG","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86147","description":"CARDIOLIPIN (PHOSPHOLIPID) ANTIBODY, EACH IG CLASS","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":97.48,"providers":[{"billed_charge":865.57,"npi":[1740262880]}]}]}]},{"name":"CCP ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86200","description":"CYCLIC CITRULLINATED PEPTIDE (CCP), ANTIBODY","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":416.64,"providers":[{"billed_charge":4605.32,"npi":[1740262880]}]}]}]},{"name":"DNA ANTIBODY NATIVE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86225","description":"DEOXYRIBONUCLEIC ACID (DNA) ANTIBODY; NATIVE OR DOUBLE STRANDED","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":136.89,"providers":[{"billed_charge":1494.68,"npi":[1740262880]}]}]}]},{"name":"NUCLEAR ANTIGEN ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86235","description":"EXTRACTABLE NUCLEAR ANTIGEN, ANTIBODY TO, ANY METHOD (EG, NRNP, SS-A, SS-B, SM, RNP, SC170, J01), EA","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1032.47,"providers":[{"billed_charge":13816.77,"npi":[1740262880]}]}]}]},{"name":"IMMUNOASSAY, TUMOR, CA 15-3","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86300","description":"IMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 15-3 (27.29)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":957.00,"providers":[{"billed_charge":10154.14,"npi":[1740262880]}]}]}]},{"name":"IMMUNOASSAY, TUMOR, CA 19-9","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86301","description":"IMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 19-9","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":63.80,"providers":[{"billed_charge":685.65,"npi":[1740262880]}]}]}]},{"name":"IMMUNOASSAY, TUMOR, CA 125","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86304","description":"IMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 125","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":382.80,"providers":[{"billed_charge":4290.54,"npi":[1740262880]}]}]}]},{"name":"IMMUNOASSAY INFECTIOUS AGENT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86317","description":"IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY, QUANTITATIVE, NOT OTHERWISE SPECIFIED","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":206.81,"providers":[{"billed_charge":1772.40,"npi":[1740262880]}]}]}]},{"name":"MICROSOMAL ANTIBODY EACH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86376","description":"MICROSOMAL ANTIBODIES (EG, THYROID OR LIVER-KIDNEY), EACH","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1862.08,"providers":[{"billed_charge":21683.94,"npi":[1740262880]}]}]}]},{"name":"RHEUMATOID FACTOR, QUANT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86431","description":"RHEUMATOID FACTOR; QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":321.90,"providers":[{"billed_charge":3490.94,"npi":[1740262880]}]}]}]},{"name":"TB TEST CELL IMMUN MEASURE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86480","description":"TUBERCULOSIS TEST, CELL MEDIATED IMMUNITY ANTIGEN RESPONSE MEASUREMENT; GAMMA INTERFERON","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2421.99,"providers":[{"billed_charge":12155.85,"npi":[1740262880]}]}]}]},{"name":"SYPHILIS TEST NON-TREP QUAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86592","description":"SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUALITATIVE (EG, VDRL, RPR, ART)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1818.12,"providers":[{"billed_charge":18696.55,"npi":[1740262880]}]}]}]},{"name":"COCCIDIOIDES ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86635","description":"ANTIBODY; COCCIDIOIDES","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1063.59,"providers":[{"billed_charge":13589.72,"npi":[1740262880]}]}]}]},{"name":"HERPES SIMPLEX TYPE 1 TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86695","description":"ANTIBODY; HERPES SIMPLEX, TYPE 1","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1162.65,"providers":[{"billed_charge":10615.34,"npi":[1740262880]}]}]}]},{"name":"HERPES SIMPLEX TYPE 2 TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86696","description":"ANTIBODY; HERPES SIMPLEX, TYPE 2","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1838.92,"providers":[{"billed_charge":16729.60,"npi":[1740262880]}]}]}]},{"name":"HEP B CORE ANTIBODY, TOTAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86704","description":"HEPATITIS B CORE ANTIBODY (HBCAB); TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":563.03,"providers":[{"billed_charge":6412.62,"npi":[1740262880]}]}]}]},{"name":"HEP B SURFACE ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86706","description":"HEPATITIS B SURFACE ANTIBODY (HBSAB)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":510.26,"providers":[{"billed_charge":5690.48,"npi":[1740262880]}]}]}]},{"name":"HEPATITIS A ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86708","description":"HEPATITIS A ANTIBODY (HAAB)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":9.50,"providers":[{"billed_charge":95.55,"npi":[1740262880]}]}]}]},{"name":"RUBELLA ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86762","description":"ANTIBODY; RUBELLA","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1422.87,"providers":[{"billed_charge":8476.46,"npi":[1740262880]}]}]}]},{"name":"TREPONEMA PALLIDUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86780","description":"ANTIBODY; TREPONEMA PALLIDUM","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":223.30,"providers":[{"billed_charge":2113.17,"npi":[1740262880]}]}]}]},{"name":"VARICELLA-ZOSTER ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86787","description":"ANTIBODY; VARICELLA-ZOSTER","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":138.30,"providers":[{"billed_charge":1660.85,"npi":[1740262880]}]}]}]},{"name":"THYROGLOBULIN ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86800","description":"THYROGLOBULIN ANTIBODY","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1032.24,"providers":[{"billed_charge":11832.96,"npi":[1740262880]}]}]}]},{"name":"HEPATITIS C AB TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86803","description":"HEPATITIS C ANTIBODY;","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3260.12,"providers":[{"billed_charge":28851.89,"npi":[1740262880]}]}]}]},{"name":"RBC ANTIBODY SCREEN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86850","description":"ANTIBODY SCREEN, RBC, EACH SERUM TECHNIQUE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1014.62,"providers":[{"billed_charge":8910.52,"npi":[1740262880]}]}]}]},{"name":"BLOOD TYPING SEROLOGIC ABO","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86900","description":"BLOOD TYPING, SEROLOGIC; ABO","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":430.92,"providers":[{"billed_charge":4093.03,"npi":[1740262880]}]}]}]},{"name":"BLOOD TYPING SEROLOGIC RH(D)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86901","description":"BLOOD TYPING, SEROLOGIC; RH (D)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":430.92,"providers":[{"billed_charge":4060.23,"npi":[1740262880]}]}]}]},{"name":"CULTURE OTHR SPECIMN AEROBIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87070","description":"CULTURE, BACTERIAL; ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC, WITH ISOLATION AND PRESU","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":171.60,"providers":[{"billed_charge":2518.31,"npi":[1740262880]}]}]}]},{"name":"CULTR BACTERIA, EXCEPT BLOOD","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87075","description":"CULTURE, BACTERIAL; ANY SOURCE, EXCEPT BLOOD, ANAEROBIC WITH ISOLATION AND PRESUMPTIVE IDENTIFICATIO","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":14.50,"providers":[{"billed_charge":262.94,"npi":[1740262880]}]}]}]},{"name":"CULTURE AEROBIC IDENTIFY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87077","description":"CULTURE, BACTERIAL; AEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR DEFINITIVE IDENTIFICATION, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":476.63,"providers":[{"billed_charge":1874.64,"npi":[1740262880]}]}]}]},{"name":"CULTURE SCREEN ONLY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87081","description":"CULTURE, PRESUMPTIVE, PATHOGENIC ORGANISMS, SCREENING ONLY;","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":792.49,"providers":[{"billed_charge":6497.22,"npi":[1740262880]}]}]}]},{"name":"URINE CULTURE/COLONY COUNT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87086","description":"CULTURE, BACTERIAL; QUANTITATIVE COLONY COUNT, URINE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3980.17,"providers":[{"billed_charge":33086.73,"npi":[1740262880]}]}]}]},{"name":"URINE BACTERIA CULTURE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87088","description":"CULTURE, BACTERIAL; WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF EACH ISOLATE, URINE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1124.01,"providers":[{"billed_charge":5122.03,"npi":[1740262880]}]}]}]},{"name":"DNA/RNA AMPLIFIED PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87150","description":"CULTURE, TYPING; IDENTIFICATION BY NUCLEIC ACID (DNA OR RNA) PROBE, AMPLIFIED PROBE TECHNIQUE, PER C","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2366.33,"providers":[{"billed_charge":8556.78,"npi":[1740262880]}]}]}]},{"name":"MICROBE SUSCEPTIBLE MIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87186","description":"SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MICRODILUTION OR AGAR DILUTION (MINIMUM INHIBITORY CONC","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1085.75,"providers":[{"billed_charge":13385.90,"npi":[1740262880]}]}]}]},{"name":"HEPATITIS B SURFACE AG IA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87340","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HEPATITIS B SURFACE ANTIGEN (HBSAG); (E","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1905.54,"providers":[{"billed_charge":18165.61,"npi":[1740262880]}]}]}]},{"name":"HIV-1 AG W/HIV-1 & HIV-2 AB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87389","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HIV-1 ANTIGEN(S), W HIV-1 AND HIV-2 ANT","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":6949.80,"providers":[{"billed_charge":59222.12,"npi":[1740262880]}]}]}]},{"name":"CANDIDA, DNA, DIR PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87480","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES, DIRECT PROBE TECHNIQUE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":215.18,"providers":[{"billed_charge":1592.45,"npi":[1740262880]}]}]}]},{"name":"CHYLMD TRACH, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87491","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":21934.33,"providers":[{"billed_charge":87456.34,"npi":[1740262880]}]}]}]},{"name":"GARDNER VAG, DNA, DIR PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87510","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); GARDNERELLA VAGINALIS, DIRECT PROBE TECHNIQ","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":215.18,"providers":[{"billed_charge":1455.15,"npi":[1740262880]}]}]}]},{"name":"HEPATITIS C REVRS TRNSCRPJ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87522","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS C, QUANTIFICATION, INCLUDES REVER","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":131.28,"providers":[{"billed_charge":1581.00,"npi":[1740262880]}]}]}]},{"name":"M. GENITALIUM AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87563","description":"IADNA MYCOPLASMA GENITALIUM AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1505.84,"providers":[{"billed_charge":4842.25,"npi":[1740262880]}]}]}]},{"name":"N.GONORRHOEAE, DNA, AMP PROB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87591","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHOEAE, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":21934.33,"providers":[{"billed_charge":87413.59,"npi":[1740262880]}]}]}]},{"name":"HPV HIGH-RISK TYPES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87624","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":16952.56,"providers":[{"billed_charge":77661.61,"npi":[1740262880]}]}]}]},{"name":"Infectious Agent Antigen Detection","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87626","description":"the detection of human papillomavirus (HPV) by nucleic acid (DNA or RNA) tests, specifically reporting separately the high-risk types (16, 18, 31, 45, 51, and 52) and any high-risk pooled results.","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":826.32,"providers":[{"billed_charge":4385.85,"npi":[1740262880]}]}]}]},{"name":"TRICHOMONAS VAGIN, DIR PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87660","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); TRICHOMONAS VAGINALIS, DIRECT PROBE TECHNIQ","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":476.47,"providers":[{"billed_charge":3266.25,"npi":[1740262880]}]}]}]},{"name":"TRICHOMONAS VAGINALIS AMPLIF","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87661","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); TRICHOMONAS VAGINALIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5724.85,"providers":[{"billed_charge":32418.85,"npi":[1740262880]}]}]}]},{"name":"DETECT AGENT NOS, DNA, AMP","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87798","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE SPECIFIED; AMPLIFIED PROBE TE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1936.23,"providers":[{"billed_charge":8206.05,"npi":[1740262880]}]}]}]},{"name":"DETECT AGNT MULT, DNA, AMPLI","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87801","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), MULTIPLE ORGANISMS; AMPLIFIED PROBE(S) TECH","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":10489.05,"providers":[{"billed_charge":35603.18,"npi":[1740262880]}]}]}]},{"name":"CYTOPATH C/V AUTO FLUID REDO","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88175","description":"CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED TH","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1360.10,"providers":[{"billed_charge":5608.05,"npi":[1740262880]}]}]}]},{"name":"TISSUE EXAM BY PATHOLOGIST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88305","description":"LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION ABORTION - SPONTANEOUS/MISSED ARTER","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4904.45,"providers":[{"billed_charge":16746.20,"npi":[1740262880]}]}]},{"tin":{"type":"ein","value":"860564320"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":512.81,"providers":[{"billed_charge":1375.00,"npi":[1205290996]}]}]}]},{"name":"PSYCH DIAG EVAL W/MED SRVCS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90792","description":"PSYCHIATRIC DIAGNOSTIC EVALUATION WITH MEDICAL SERVICES","allowed_amounts":[{"tin":{"type":"ein","value":"822076807"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1363.28,"providers":[{"billed_charge":8000.00,"npi":[1922112572]}]}]}]},{"name":"PSYTX W PT 30 MINUTES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90832","description":"PSYCHOTHERAPY, 30 MINUTES WITH PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"822076807"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":5095.92,"providers":[{"billed_charge":63900.00,"npi":[1922112572]}]}]}]},{"name":"PSYTX W PT 45 MINUTES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90834","description":"PSYCHOTHERAPY, 45 MINUTES WITH PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"201020949"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":1896.81,"providers":[{"billed_charge":4800.00,"npi":[1265841027]}]}]}]},{"name":"PSYTX W PT 60 MINUTES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90837","description":"PSYCHOTHERAPY, 60 MINUTES WITH PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"824104161"},"service_code":["11","12"],"billing_class":"professional","payments":[{"allowed_amount":103.32,"providers":[{"billed_charge":175.00,"npi":[1033618103]}]},{"allowed_amount":326.98,"providers":[{"billed_charge":525.00,"npi":[1033618103]}]}]},{"tin":{"type":"ein","value":"990632329"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":400.26,"providers":[{"billed_charge":420.00,"npi":[1174221741]}]}]},{"tin":{"type":"ein","value":"455370086"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":137.75,"providers":[{"billed_charge":250.00,"npi":[1437739596]}]}]},{"tin":{"type":"ein","value":"571203051"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":688.75,"providers":[{"billed_charge":1100.00,"npi":[1023726866]}]},{"allowed_amount":275.50,"providers":[{"billed_charge":440.00,"npi":[1023726866]}]}]},{"tin":{"type":"ein","value":"825200383"},"service_code":["11","12","10"],"billing_class":"professional","payments":[{"allowed_amount":894.60,"providers":[{"billed_charge":1320.00,"npi":[1922403658]}]},{"allowed_amount":1709.75,"providers":[{"billed_charge":2640.00,"npi":[1093362329]}]},{"allowed_amount":2340.20,"providers":[{"billed_charge":3520.00,"npi":[1093362329]}]},{"allowed_amount":424.60,"providers":[{"billed_charge":660.00,"npi":[1922403658]}]},{"allowed_amount":1938.30,"providers":[{"billed_charge":2860.00,"npi":[1093362329]}]},{"allowed_amount":596.40,"providers":[{"billed_charge":880.00,"npi":[1922403658]}]}]}]},{"name":"PSYTX W PT W E/M 60 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90838","description":"PSYCHOTHERAPY, 60 MINUTES WITH PATIENT WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE","allowed_amounts":[{"tin":{"type":"ein","value":"61040288"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":4950.00,"providers":[{"billed_charge":4950.00,"npi":[1952430647]}]}]}]},{"name":"SPEECH/HEARING THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"92507","description":"TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/OR AUDITORY PROCESSING DISORDER; INDIVIDUAL","allowed_amounts":[{"tin":{"type":"ein","value":"201015104"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":118.56,"providers":[{"billed_charge":448.00,"npi":[1780163055]}]}]}]},{"name":"ELECTROCARDIOGRAM REPORT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"93010","description":"ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; INTERPRETATION AND REPORT ONLY","allowed_amounts":[{"tin":{"type":"ein","value":"201291415"},"service_code":["22","11","19","21"],"billing_class":"professional","payments":[{"allowed_amount":19.80,"providers":[{"billed_charge":33.00,"npi":[1568480093]}]},{"allowed_amount":39.60,"providers":[{"billed_charge":66.00,"npi":[1568480093]}]},{"allowed_amount":97.20,"providers":[{"billed_charge":162.00,"npi":[1568480093]}]}]},{"tin":{"type":"ein","value":"860137567"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":48.52,"providers":[{"billed_charge":350.00,"npi":[1851622112]}]},{"allowed_amount":90.04,"providers":[{"billed_charge":650.00,"npi":[1851622112]}]},{"allowed_amount":75.56,"providers":[{"billed_charge":550.00,"npi":[1851622112]}]}]}]},{"name":"IMMUNOTHERAPY, ONE INJECTION","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"95115","description":"PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF ALLERGENIC EXTRACTS; SIN","allowed_amounts":[{"tin":{"type":"ein","value":"873164803"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":198.72,"providers":[{"billed_charge":591.12,"npi":[1407016348]}]}]}]},{"name":"IMMUNOTHERAPY INJECTIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"95117","description":"PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF ALLERGENIC EXTRACTS; 2 O","allowed_amounts":[{"tin":{"type":"ein","value":"873164803"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1140.14,"providers":[{"billed_charge":3209.36,"npi":[1407016348]}]},{"allowed_amount":426.49,"providers":[{"billed_charge":1203.51,"npi":[1851382550]}]}]}]},{"name":"ANTIGEN THERAPY SERVICES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"95165","description":"PROF SERVICES FOR THE SPRVSN OF PREPARATION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHAPY; SING","allowed_amounts":[{"tin":{"type":"ein","value":"873164803"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2156.99,"providers":[{"billed_charge":4323.80,"npi":[1407016348]}]},{"allowed_amount":854.59,"providers":[{"billed_charge":1750.00,"npi":[1851382550]}]}]}]},{"name":"PT-FOCUSED HLTH RISK ASSMT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"96160","description":"ADMINISTRATION OF PATIENT-FOCUSED HEALTH RISK ASSESSMENT INSTRUMENT (EG, HEALTH HAZARD APPRAISAL) WI","allowed_amounts":[{"tin":{"type":"ein","value":"203134104"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":17.02,"providers":[{"billed_charge":46.06,"npi":[1073578159]}]},{"allowed_amount":12.24,"providers":[{"billed_charge":32.90,"npi":[1073578159]}]},{"allowed_amount":19.43,"providers":[{"billed_charge":52.64,"npi":[1033166012]}]}]}]},{"name":"ADAPTIVE BEHAVIOR TX BY TECH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97153","description":"ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"271402749"},"service_code":["11","12"],"billing_class":"professional","payments":[{"allowed_amount":10851.75,"providers":[{"billed_charge":22800.00,"npi":[1497554901]}]},{"allowed_amount":12115.80,"providers":[{"billed_charge":25400.00,"npi":[1427845569]}]},{"allowed_amount":7465.05,"providers":[{"billed_charge":15650.00,"npi":[1477446680]}]},{"allowed_amount":333.90,"providers":[{"billed_charge":700.00,"npi":[1477446680]}]}]}]},{"name":"Under Established Patient","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98006","description":"Under Established Patient","allowed_amounts":[{"tin":{"type":"ein","value":"203134104"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":1610.78,"providers":[{"billed_charge":6285.77,"npi":[1073578159]}]},{"allowed_amount":499.08,"providers":[{"billed_charge":1984.98,"npi":[1033166012]}]}]}]},{"name":"PRO FEE/ER","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"981","description":"PROFESSIONAL FEES - EMERGENCY ROOM","allowed_amounts":[{"tin":{"type":"ein","value":"721561132"},"service_code":["20"],"billing_class":"institutional","payments":[{"allowed_amount":1458.00,"providers":[{"billed_charge":1944.00,"npi":[1700910189]}]}]}]},{"name":"Under Remote Therapeutic Monitoring Services","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98978","description":"Under Remote Therapeutic Monitoring Services","allowed_amounts":[{"tin":{"type":"ein","value":"923862746"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1134.47,"providers":[{"billed_charge":3781.43,"npi":[1124405915]}]}]}]},{"name":"REM THER MNTR 1ST 20 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98980","description":"REMOTE THER MNTR TX MGMT PHYS/QHP 1ST 20 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"923862746"},"service_code":["11","22"],"billing_class":"professional","payments":[{"allowed_amount":1727.10,"providers":[{"billed_charge":1838.51,"npi":[1124405915]}]},{"allowed_amount":23.92,"providers":[{"billed_charge":40.15,"npi":[1124405915]}]}]}]},{"name":"REM THER MNTR EA ADDL 20 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98981","description":"REMOTE THER MNTR TX MGMT PHYS/QHP EA ADDL 20 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"923862746"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1902.98,"providers":[{"billed_charge":1978.83,"npi":[1124405915]}]}]}]},{"name":"MED SERV EVE/WKEND/HOLIDAY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99051","description":"SERVICE(S) PROVIDED IN THE OFFICE DURING REGULARLY SCHEDULED EVENING, WEEKEND, OR HOLIDAY OFFICE HOU","allowed_amounts":[{"tin":{"type":"ein","value":"203134104"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":34.00,"providers":[{"billed_charge":240.00,"npi":[1073578159]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99211","description":"OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, THAT M","allowed_amounts":[{"tin":{"type":"ein","value":"237086112"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2712.36,"providers":[{"billed_charge":4053.06,"npi":[1477016921]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99213","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"61040288"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":6300.00,"providers":[{"billed_charge":6300.00,"npi":[1952430647]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99214","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"203134104"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":104.57,"providers":[{"billed_charge":315.70,"npi":[1073578159]}]},{"allowed_amount":1878.01,"providers":[{"billed_charge":5366.90,"npi":[1639243058]}]},{"allowed_amount":1957.50,"providers":[{"billed_charge":5682.60,"npi":[1073578159]}]}]},{"tin":{"type":"ein","value":"473723202"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":179.11,"providers":[{"billed_charge":370.00,"npi":[1407548845]}]}]},{"tin":{"type":"ein","value":"873164803"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":719.92,"providers":[{"billed_charge":1300.00,"npi":[1407016348]}]}]},{"tin":{"type":"ein","value":"200589060"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1098.58,"providers":[{"billed_charge":1800.00,"npi":[1659379378]}]}]},{"tin":{"type":"ein","value":"812124295"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1196.78,"providers":[{"billed_charge":3000.00,"npi":[1932557675]}]}]},{"tin":{"type":"ein","value":"454995568"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":3157.93,"providers":[{"billed_charge":5075.00,"npi":[1891971628]}]},{"allowed_amount":1016.37,"providers":[{"billed_charge":1575.00,"npi":[1891971628]}]},{"allowed_amount":4709.76,"providers":[{"billed_charge":7700.00,"npi":[1891971628]}]}]},{"tin":{"type":"ein","value":"262236406"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":184.87,"providers":[{"billed_charge":412.92,"npi":[1578942165]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99215","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"823913679"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1321.11,"providers":[{"billed_charge":3913.38,"npi":[1932467727]}]}]}]},{"name":"SUBSEQUENT HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99232","description":"SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT","allowed_amounts":[{"tin":{"type":"ein","value":"452951380"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":75.68,"providers":[{"billed_charge":150.00,"npi":[1013085257]}]}]},{"tin":{"type":"ein","value":"832602750"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":277.92,"providers":[{"billed_charge":400.00,"npi":[1528374303]}]}]}]},{"name":"SUBSEQUENT HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99233","description":"SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT","allowed_amounts":[{"tin":{"type":"ein","value":"264691812"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":474.20,"providers":[{"billed_charge":1122.90,"npi":[1063446425]}]}]},{"tin":{"type":"ein","value":"363966745"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1657.32,"providers":[{"billed_charge":3000.00,"npi":[1679662381]}]}]},{"tin":{"type":"ein","value":"824555574"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":7328.14,"providers":[{"billed_charge":12100.00,"npi":[1760456032]}]}]},{"tin":{"type":"ein","value":"832602750"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":3161.40,"providers":[{"billed_charge":4500.00,"npi":[1528374303]}]}]}]},{"name":"EMERGENCY DEPT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99285","description":"EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE","allowed_amounts":[{"tin":{"type":"ein","value":"352574944"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":751.08,"providers":[{"billed_charge":10566.00,"npi":[1366563249]}]}]}]},{"name":"NURSING FAC CARE SUBSEQ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99308","description":"SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQ","allowed_amounts":[{"tin":{"type":"ein","value":"473099351"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":1182.40,"providers":[{"billed_charge":2749.20,"npi":[1689301293]}]}]},{"tin":{"type":"ein","value":"471098491"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":2729.35,"providers":[{"billed_charge":4549.05,"npi":[1467560565]}]}]},{"tin":{"type":"ein","value":"860831961"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":551.88,"providers":[{"billed_charge":849.00,"npi":[1982637849]}]}]}]},{"name":"NURSING FAC CARE SUBSEQ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99309","description":"SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQ","allowed_amounts":[{"tin":{"type":"ein","value":"472188010"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":4503.39,"providers":[{"billed_charge":7505.64,"npi":[1740420041]}]}]},{"tin":{"type":"ein","value":"860975566"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":915.75,"providers":[{"billed_charge":1221.00,"npi":[1992866651]}]}]},{"tin":{"type":"ein","value":"471554329"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":706.32,"providers":[{"billed_charge":1780.00,"npi":[1720688443]}]}]},{"tin":{"type":"ein","value":"473350388"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":3600.92,"providers":[{"billed_charge":7955.00,"npi":[1659771186]}]}]},{"tin":{"type":"ein","value":"843902969"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":608.52,"providers":[{"billed_charge":1216.98,"npi":[1679235808]}]}]}]},{"name":"PROLNG OFF/OP E/M EA 15 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99417","description":"PROLONGED OFFICE/OUTPATIENT E/M SVC EA 15 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"823913679"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1141.36,"providers":[{"billed_charge":4344.30,"npi":[1932467727]}]}]}]},{"name":"1ST PSYC COLLAB CARE MGMT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99492","description":"INITIAL PSYCHIATRIC COLLABORATIVE CARE MANAGEMENT, FIRST 70 MINUTES IN THE FIRST CALENDAR MONTH OF B","allowed_amounts":[{"tin":{"type":"ein","value":"923862746"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1175.08,"providers":[{"billed_charge":1215.78,"npi":[1124405915]}]}]}]},{"name":"SBSQ PSYC COLLAB CARE MGMT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99493","description":"SUBSEQUENT PSYCHIATRIC COLLABORATIVE CARE MANAGEMENT, FIRST 60 MINUTES IN A SUBSEQUENT MONTH OF BEHA","allowed_amounts":[{"tin":{"type":"ein","value":"923862746"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":7291.56,"providers":[{"billed_charge":7790.48,"npi":[1124405915]}]}]}]},{"name":"1ST/SBSQ PSYC COLLAB CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99494","description":"INITIAL OR SUBSEQUENT PSYCHIATRIC COLLABORATIVE CARE MANAGEMENT, EACH ADDITIONAL 30 MINUTES IN A CAL","allowed_amounts":[{"tin":{"type":"ein","value":"923862746"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":14356.45,"providers":[{"billed_charge":15231.81,"npi":[1124405915]}]}]}]},{"name":"BLS ROUTINE DISPOSABLE SUPPL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0382","description":"BLS ROUTINE DISPOSABLE SUPPLIES","allowed_amounts":[{"tin":{"type":"ein","value":"300824958"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":158.07,"providers":[{"billed_charge":158.07,"npi":[1851781314]}]}]}]},{"name":"ALS ROUTNE DISPSABLE SUPPLS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0398","description":"ALS ROUTINE DISPOSABLE SUPPLIES","allowed_amounts":[{"tin":{"type":"ein","value":"300824958"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":15.56,"providers":[{"billed_charge":15.56,"npi":[1851781314]}]}]}]},{"name":"GRND MLGE PER STATUTE MILE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0425","description":"GROUND MILEAGE, PER STATUTE MILE","allowed_amounts":[{"tin":{"type":"ein","value":"866000256"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":832.99,"providers":[{"billed_charge":837.98,"npi":[1982781571]}]}]},{"tin":{"type":"ein","value":"860110232"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1602.62,"providers":[{"billed_charge":1679.60,"npi":[1518143205]}]}]},{"tin":{"type":"ein","value":"300824958"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":259.38,"providers":[{"billed_charge":274.34,"npi":[1851781314]}]}]}]},{"name":"AMB SVC ALS ER TRNSPRT LVL1","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0427","description":"AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, EMERGENCY TRANSPORT, LEVEL 1 (ALS 1 - EMERGENCY)","allowed_amounts":[{"tin":{"type":"ein","value":"860110232"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9930.18,"providers":[{"billed_charge":10452.84,"npi":[1518143205]}]}]}]},{"name":"AMB SERVICE BLS NONEMERG TRA","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0428","description":"AMBULANCE SERVICE, BASIC LIFE SUPPORT, NONEMERGENCY TRANSPORT, (BLS)","allowed_amounts":[{"tin":{"type":"ein","value":"300824958"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9642.33,"providers":[{"billed_charge":9642.33,"npi":[1851781314]}]}]}]},{"name":"PROSTATE CANCER SCREENING","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0103","description":"PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3057.53,"providers":[{"billed_charge":25342.29,"npi":[1740262880]}]}]}]},{"name":"SCR CERV/VAG THIN LAY W/PHYS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0123","description":"SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AU","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":232.95,"providers":[{"billed_charge":930.15,"npi":[1740262880]}]}]}]},{"name":"SCR CERV/VAG THIN LAY PHYS I","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0124","description":"SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AU","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":443.70,"providers":[{"billed_charge":2289.72,"npi":[1740262880]}]}]}]},{"name":"SCR CERV/VAG AUTO&MNL RSCR P","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0145","description":"SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AU","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":14595.31,"providers":[{"billed_charge":67554.00,"npi":[1740262880]}]}]}]},{"name":"DX DIGTL BRST TOMOSYN UNI/BI","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0279","description":"DIAGNOSTIC DIGITAL BREAST TOMOSYNTHESIS, UNILATERAL OR BILATERAL (LIST SEPARATELY IN ADDITION TO 770","allowed_amounts":[{"tin":{"type":"ein","value":"200382536"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":39.66,"providers":[{"billed_charge":244.00,"npi":[1154558039]}]}]}]},{"name":"COLOREC CA SCR; FOB TST IMMU","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0328","description":"COLORECTAL CANCER SCREENING; FECAL OCCULT BLOOD TEST, IMMUNOASSAY, 1-3 SIMULTANEOUS DETERMINATIONS","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":91.08,"providers":[{"billed_charge":897.75,"npi":[1740262880]}]}]}]},{"name":"HEP C ABO SC IND HI RSK&OTH","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0472","description":"HEPATITIS C ANTIBODY SCREENING FOR INDIVIDUAL AT HIGH RISK AND OTHER COVERED INDICATION(S)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":248.00,"providers":[{"billed_charge":1318.54,"npi":[1740262880]}]}]}]},{"name":"HIV ANTIGEN/ANTIBODY, COMBIN","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0475","description":"HIV ANTIGEN/ANTIBODY, COMBINATION ASSAY, SCREENING","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":666.90,"providers":[{"billed_charge":6610.80,"npi":[1740262880]}]}]}]},{"name":"Code for Visit complexity inherent to hospital inpatient or observation care associated with a confirmed or suspected infectious disease by an infectious diseases specialist, including disease transmission risk assessment and mitigation, public health investigation, analysis, and testing, and complex antimicrobial therapy counseling and treatment (add-on code, list separately in addition to hospital inpatient or observation evaluation and management visit, initial, same day discharge, subsequent or discharge)","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0545","description":"Code for Visit complexity inherent to hospital inpatient or observation care associated with a confirmed or suspected infectious disease by an infectious diseases specialist, including disease transmission risk assessment and mitigation, public health investigation, analysis, and testing, and complex antimicrobial therapy counseling and treatment (add-on code, list separately in addition to hospital inpatient or observation evaluation and management visit, initial, same day discharge, subsequent or discharge)","allowed_amounts":[{"tin":{"type":"ein","value":"832602750"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1925.00,"providers":[{"billed_charge":1925.00,"npi":[1528374303]}]}]}]},{"name":"VISIT CPLX INHERENT E&M ASSO","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2211","description":"VISIT CPLX INHERENT E&M ASSOC WITH MED CARE SRVC","allowed_amounts":[{"tin":{"type":"ein","value":"900730397"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":46.26,"providers":[{"billed_charge":98.00,"npi":[1003098070]}]},{"allowed_amount":117.32,"providers":[{"billed_charge":245.00,"npi":[1003098070]}]}]}]},{"name":"BEHAVIORAL HEALTH CNSL&TX-15","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0004","description":"BEHAVIORAL HEALTH COUNSELING AND THERAPY, PER 15 MINUTES","allowed_amounts":[{"tin":{"type":"ein","value":"460624198"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":1658.46,"providers":[{"billed_charge":2800.00,"npi":[1205638368]}]},{"allowed_amount":696.00,"providers":[{"billed_charge":1200.00,"npi":[1689438921]}]},{"allowed_amount":932.61,"providers":[{"billed_charge":1400.00,"npi":[1205638368]}]}]}]},{"name":"ALCOHL&/RX SRVC;METHDONE ADM","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0020","description":"ALCOHOL AND/OR DRUG SERVICES; METHADONE ADMINISTRATION AND/OR SERVICE (PROVISION OF THE DRUG BY A LI","allowed_amounts":[{"tin":{"type":"ein","value":"860606635"},"service_code":["53"],"billing_class":"professional","payments":[{"allowed_amount":34.44,"providers":[{"billed_charge":81.60,"npi":[1043462526]}]}]}]},{"name":"ORAL MEDADMIN DIR OBSERV","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0033","description":"ORAL MEDICATION ADMINISTRATION, DIRECT OBSERVATION","allowed_amounts":[{"tin":{"type":"ein","value":"237086112"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":999.36,"providers":[{"billed_charge":3997.62,"npi":[1477016921]}]}]}]},{"name":"COMP MDICTION SVC PER 15 MIN","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H2010","description":"COMPREHENSIVE MEDICATION SERVICES, PER 15 MINUTES","allowed_amounts":[{"tin":{"type":"ein","value":"860606635"},"service_code":["53"],"billing_class":"professional","payments":[{"allowed_amount":405.99,"providers":[{"billed_charge":609.96,"npi":[1043462526]}]}]}]},{"name":"CRISIS INTRVNT MNTL HLTH SVC","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"S9485","description":"CRISIS INTERVENTION MENTAL HEALTH SERVICES, PER DIEM","allowed_amounts":[{"tin":{"type":"ein","value":"364872543"},"service_code":["99"],"billing_class":"professional","payments":[{"allowed_amount":2156.44,"providers":[{"billed_charge":8625.68,"npi":[1982362943]}]}]},{"tin":{"type":"ein","value":"942880847"},"service_code":["99"],"billing_class":"professional","payments":[{"allowed_amount":44625.00,"providers":[{"billed_charge":178500.00,"npi":[1891288049]}]},{"allowed_amount":3000.00,"providers":[{"billed_charge":12000.00,"npi":[1285127043]}]}]}]}]}